Placental findings in singleton stillbirths

Area of Science:

• Perinatal pathology
• Obstetrics
• Fetal medicine

Background:

• Stillbirth remains a significant concern in perinatal medicine.
• Placental abnormalities are increasingly recognized as a major contributor to stillbirth.
• Comparative analysis of placental findings in stillbirth versus live birth is essential for understanding etiology.

Purpose of the Study:

• To compare the prevalence of various placental lesions between stillbirth cases and live birth controls.
• To investigate the association of specific placental lesions with stillbirth across different gestational ages.

Main Methods:

• A population-based study involving pathologic examination of placentas from 518 stillbirths and 1,200 live births.
• Standardized protocol for placental examination and data analysis, stratified by gestational age at delivery.

Main Results:

• Significant associations were found between numerous placental lesions and stillbirth, including single umbilical artery, velamentous cord insertion, villous immaturity, inflammation, vascular changes, retroplacental hematoma, thrombi, infarction, fibrin deposition, fetal vascular thrombi, avascular villi, and hydrops.
• Inflammatory lesions and retroplacental hematoma were more frequent in early stillbirths, while thrombotic lesions predominated in later gestations.
• Inflammatory lesions were also noted in early live births, but at lower frequencies than in stillbirths.

Conclusions:

• Placental lesions exhibit a strong association with stillbirth.
• While many stillbirth-associated lesions occur in live births, their prevalence and distribution vary significantly with gestational age.
• This study enhances understanding of placental abnormality's role in stillbirth by detailing lesion prevalence across gestational age groups in both stillbirth and live birth cohorts.